Personal/Auto Loan Application

IMPORTANT: Please read these directions before completing this Application, and check (a) the appropriate box below.

If you are applying for individual credit in your own name,, and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete only Sections A and D. If the requested credit is to be secured, also complete the first part of Section C and Section E.

If you are applying for joint credit with another person, complete all Sections Except E, providing information in B about the joint applicant. If the requested credit is to be secured, then complete Section E. We intend to apply for joint credit:
Applicant Co-Applicant

If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another personas the basis for repayment of the credit requested, complete all sections except E to the extent possible, providing information in B about the person on whose alimony, support, or maintenance payments or income or assets you are relying. If the requested credit is to be secured, then complete Section E.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, the USA Patriot Act requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, physical address, date of birth, taxpayer identification number and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. We will let you know if additional information is required.
Loan Information Type of Application  
Personal Loan  Auto Loan
Loan Request:
$ for months
Dealer Purchase  Lease Buyout
Private Purchase  Refinance
New  Used 
Year
Insurance Co.   
Phone 		Individual credit
Joint credit with spouse
Joint credit with

who is not your spouse and must complete a separate application

Section A
Applicant Information
Name
 Social Security Number
 Birth Date
 Driver's License
 State
 Email Address
Street Address
 City
 State
 Zip
 Time At Present Address
Yrs:  Mos: 		Mailing Address
Home Phone
 Cell Phone
 Name of friend/relative not living with you
Relationship
Phone of friend/relative not living with you
Previous Street Address(if less than 2 years current)
 City
 State
 Zip
 Time At Previous Address
Yrs:  Mos:
Employer's Name
 Address
 City
Position/Title
 Work Phone
 Time There
Yrs:  Mos: 		Supervisor
  
Gross Monthly Income
 Other Income $ per month   
Source:
Note: Alimony, Child Support or Separate Maintenance Incomes do not have to be revealed unless you wish to have them considered in loan qualification.
Previous Employer (if less than 3 years at current)
Address
 Time There
Yrs: Mos:
Bank References
Name
Checking Acc't No.
 Savings Acc't No
  
Name
Checking Acc't No.
 Savings Acc't No
  
Section B
Joint Applicant Information
Name
 Social Security Number
 Birth Date
 Driver's License
 State
  
Relationship to Applicant
 Mailing Address:
 City
 State
 Zip
Street Address
 City
 State
 Zip
 Time at Present Address
Yrs: Mos: 		Home Phone
  
Name of friend/relative not living with you
 Relationship
 Phone of friend/relative not living with you
  
Gross Monthly Income
 Other Income $ per month   
Source:
Note: Alimony, Child Support or Separate Maintenance Incomes do not have to be revealed unless you wish to have them considered in loan qualification.
Employer's Name
 Address
 City
Position/Title
 Work Phone
 Time There
Yrs:  Mos: 		Supervisor
Previous Employer (if less than 3 years at current)
Address
 Time There
Yrs: Mos:
Bank References
Name
Checking Acc't No.
 Savings Acc't No
Name
Checking Acc't No.
 Savings Acc't No
 
Section C
Marital Information
Applicant:  Married Separated Unmarried (including single, divorced, or widowed)
Co-Applicant:  Married Separated Unmarried (including single, divorced, or widowed)
 
Section D
Home Information
Rent  Own First Mortgage Holder or Landlord Address
Purchase Date/House
 Purchase Price
 Estimated Current Value
 Balance Owing
 Mortgage No.
 Monthly Payment/Rent
Credit Reference (List all debts, including second mortgage).  Attach separate sheet if needed.
Name of Lender
 Address
 Account No.
Original Amount
 Balance
 Mo. Payment
           
Have you or your Joint Applicant ever:        
Declared Bankruptcy? Yes No          Had a Judgment? Yes No          Had a repossession or foreclosure? Yes No
If yes, please Explain:
 
           
Section E - SECURED CREDIT (Complete only if credit is to be secured.) Briefly describe the property to be given as security:

Property Description

Names & Addresses of All Co-Owners of the Property

If The Security is Real Estate, Give The Full Name of Your Spouse (if any):
           
CREDIT DISCLOSURES: An insurance product or annuity may be offered to you. If you purchase an insurance product or an annuity: (1) The insurance product or annuity is not a deposit or other obligation of, or guaranteed by, this institution or our affiliate(s); (2) With exception of Federal Flood Insurance or Federal Crop Insurance, the insurance product or annuity is not insured by the Federal Deposit Insurance Corporation or any other agency of the United States, this institution, or our affiliate(s); and (3) In the case of an insurance product or annuity that involves an investment risk, there is investment risk associated with the insurance product, including the possible loss of value. If an insurance product or annuity is offered we cannot condition an extension of credit on either of the following: (1) Your purchase of an insurance product or annuity from us or any of our affiliates; or, (2) Your agreement not to obtain, or a prohibition on you from obtaining, an insurance product or annuity from an unaffiliated entity.
Agreement/Signature      
I certify that all information provided by me is true, correct and complete. I authorize The Citizens National Bank to make whatever inquires about me you deem necessary and appropriate for the purposes of evaluating my credit application. including credit reports and contacting my employer. I also authorize The Citizens National Bank to provide credit information about its credit experience with me to other creditors and credit reporting agencies.
 
Applicant's Signature Date Other's Signature
(Spouse should sign only if applying for a joint credit)		 Date
 
Please check here to indicate that all information provided is accurate and you are ready to submit this application.
 
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